Year: 2013
Type: article
Study design: Observational Study
Abstract: Background : Hydrogen cyanide (HCN) intoxication may cause or contribute to many fatalities among fi re victims.A rapid diagnostic method is missing which could tell if HCN poisoning is relevant.Thus the European RISK-study was carried out to relate blood cyanide concentrations in victims of smoke from fi res with characteristic clinical symptoms. Methods:The study was performed in hospitals and emergency departments in Belgium, France, Germany, Italy and Spain.The study centers received case report forms, and material needed for shipment of refrigerated (4 ° C) or frozen blood samples.The samples were sent to a reference laboratory for the determination of HCN.The following inclusion criteria were used: Closed-space fi re, soot deposits, altered neurological status, blood sampling prior to antidote treatment.The study protocol did not demand any further invasive or therapeutic measures.Results: 102 patients (f:39, m:63) were included.There were no blood samples available in 2 cases.One patient with an extremely high level of Cyanide (195.6 μ mol/l) was statistically rated as outlier.In 25 patients the cyanide concentration in blood was below the detection limit of 1.2 μ mol/l.The average of the cyanide levels above the detection limit ( n ϭ 74) was 13.9 Ϯ 25 μ mol/l ( 95% CI: 8.1 -19.7).By comparing the mean blood cyanide concentrations there were signifi cantly higher levels in patients with absent pulse, respiratory arrest, confusion, dyspnea, and convulsions.A correlation between GCS score and cyanide levels could be shown ( p Ͻ 0.01).It could be found that cyanide poisoning could be expected if soot particles can be detected in multiple places.Confi rmed correlation also existed between COHb and HCN levels ( p Ͻ 0.001).60% of the patients could escape from the fi re of their own, 39% had to be rescued.A signifi cant difference was calculated between these two groups for age ( p ϭ 0.02), cyanide levels ( 6.2 vs 24.1 μ mol/l ( p Ͻ 0.001), GCS ( p Ͻ 0.01), COHb ( p Ͻ 0.001) and soot deposit ( p Ͻ 0.001).There was a signifi cant difference between the cyanide levels of patients in Germany compared with patients from other countries ( 24.6 vs 7.6 μ mol/l).Conclusion: There are some characteristic clinical signs which may indicate a cyanide intoxication of patients who have been exposed to fi res with smoke.There appears a particular danger of cyanide poisoning in patients who could not escape on their own.Those victims should be treated immediately with hydroxocobalamine as an antidote.Elevated COHb is also an indication for this treatment.The difference in the cyanide concentrations may be due to furnishing and equipments.
Source: Clinical Toxicology
Authors: Yamamoto, Takahiro, Wood, David, Dargan, Paul I., Aaronson, Philip
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W2242004829